Open Access Minireview Article

Rational Mind and Heuristics in Medical Diagnostic Decision Making

T. Anil Kumar

Journal of Advances in Medicine and Medical Research, Page 82-87
DOI: 10.9734/BJMMR/2015/16530

The medical diagnostic label is the most important process in patient management. The decision process involves the thinking process of the caregiver which operates differently in emergencies and outpatient clinic. The heuristics aspect of the mind is more efficient in dealing with emergencies and the slower analyzing mind in outpatient setting. The heuristic approach is useful in rapid decisions and management of emergencies whereas the slower stepwise approach in outpatient treatment will help in reducing investigations, medical errors and cost of care. The article also gives an evidence based template for predicting the disease process based on positive and negative likelihood ratios.

Open Access Original Research Article

Impact of Hepatitis C Virus (HCV) on CD4+ T-Lymphocyte Count < 200 cells/µL among HIV-Positive Adults: A Longitudinal Evaluation

Prosanta K. Mondal, Stephanie Konrad, Michael Schwandt, Stuart Skinner, Hyun Ja Lim

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/17517

Aims: Previous research on whether Hepatitis C Virus (HCV)/HIV coinfection alters the natural history of HIV disease progression shows conflicting findings. The aim of this study is to investigate whether HCV/HIV coinfection has an adverse effect on the outcome of a CD4+ count < 200 cells/µL in HIV-positive adults.
Study Design: A retrospective longitudinal study.
Place and Duration of Study: Royal University Hospital and West Side Community Clinic in Saskatoon, Canada. Individuals were diagnosed with HIV between January 1, 2005 and September 1, 2011.
Methodology: Data were collected using medical charts. CD4+ count was dichotomized into a binary variable (1 for CD4+ count < 200; 0 for ≥ 200). Independent t-tests or Wilcoxon test, and Chi-square tests were used to compare quantitative and qualitative variables between groups, respectively. The risk factors for CD4+ count < 200 were determined using Generalized Estimating Equations (GEE) marginal logistic regression model. Analysis was done by SAS 9.4 and P<0.05 was considered as statistically significant.
Results: Among 369 patients, 48.5% were female, 72.1% were Aboriginals, 82.4% were HCV/HIV-coinfected and 77.4% had history of Injection Drug Use (IDU) at diagnosis. The mean age at diagnosis was 35.5 years. In univariate GEE logistic regression model, patients with coinfection of HCV/HIV, Aboriginals ethnicity, ever use of Antiretroviral Therapy (ART), social assistance, older age, and higher viral load at baseline were significantly more likely to have CD4+ count < 200. In multivariate model, HCV/HIV coinfection, age, and ART were associated with CD4+ count < 200. Patients with HCV/HIV coinfection, older age, and ever use of ART had significantly higher odds of having CD4+ count < 200 (adjusted odds ratios 2.21, 1.48, and 2.70 respectively).
Conclusions: HCV/HIV-coinfected patients were significantly more likely to have CD4+ count < 200. Results support earlier treatment of HCV and HIV as well as increased monitoring for coinfected individuals.

Open Access Original Research Article

Loss of Erythrocyte Deformability under Oxidative Stress is caused by Protein Oxidation with Consequent Degradation Rather than by Lipid Peroxidation

Yousif Y. Bilto

Journal of Advances in Medicine and Medical Research, Page 9-21
DOI: 10.9734/BJMMR/2015/17585

Aims: Loss of erythrocyte deformability under oxidative stress is poorly understood. The present study aimed to determine which of the detrimental effects of oxidant stress, namely, lipid peroxidation or protein degradation, is responsible for loss of erythrocyte deformability.
Methodology: Different natural and synthetic antioxidants were tested for their protective effects on erythrocyte deformability, lipid peroxidation and protein degradation after exposure to H2O2. Antioxidants used included α-Tocopherol (vitamin E), Butylated Hydroxytoluene (BHT), vitamin C, PNU-101033E, carbon monoxide (CO) and selected flavonoids and herbal extracts.
Results: Exposure of human erythrocytes in vitro to H2O2 caused loss of deformability, lipid peroxidation and protein degradation. Pre-incubation of erythrocytes with vitamin E, BHT, vitamin C, PNU-101033E, the flavonoids rutin and morin and herbal extracts of Ferula hermonisHibiscus sabdariffaTeucrium polium, prevented lipid peroxidation caused by H2O2 but did not prevent loss of erythrocyte deformability, nor protein degradation. CO, the flavonoid quercetin and herbal extracts of Nigella sativa and Allium sativumprevented both lipid peroxidation and protein degradation, but also prevented loss of erythrocyte deformability. The flavonoid 3,5,7-trihydroxy-4’-methoxy flavone-7-rutinoside prevented both protein degradation and loss of deformability, with no effect on lipid peroxidation. Vitamin C, unexpectedly, caused a significant increase in loss of erythrocyte deformability induced by H2O2 in parallel to the increased rate of protein degradation.
Conclusion: These results suggest that protein degradation rather than lipid peroxidation is responsible for loss of erythrocyte deformability under oxidative stress. Also that lipid peroxidation and protein degradation occur by independent mechanisms. This study should initiate a search for potential drugs that can prevent protein oxidation as well as lipid peroxidation, thereby acting in the prevention of adverse hemorheological consequences in disease states associated with oxidative stress. Caution should be exercised in the therapeutic use of vitamin C, especially under oxidant stress.

Open Access Original Research Article

Influence of One-Piece (Monoblock) Fibreglass Post Design on the Fracture Resistance of Extensively Damaged Teeth: An Ex vivo Study

Zeliha Gencel, Bahadir Ersu, Dilek Pinar Senyilmaz

Journal of Advances in Medicine and Medical Research, Page 22-29
DOI: 10.9734/BJMMR/2015/17606

Aims: This study compared fracture resistances of roots restored with one-piece (monoblock) fibreglass post systems having different designs.
Study Design: Original Research Paper
Place and Duration of Study: Hacettepe University, Faculty of Dentistry, Department of Prosthodontics, between June 2013 and July 2014.
Methodology: Thirty natural teeth were endodontically treated and the canal walls were flared using a taper diamond bur. The roots were randomly assigned into three groups (n=10) as Mono Core Fibre Post (MFP), Fit Fibre Post (FFP), and Conventional Fibre Post (CFP), which served as control. All posts were luted with resin cement and zirconia substructures were fabricated. Each sample was subjected to thermal-cycling (6000 times between 5- 55°C) and then the samples were loaded in a universal testing machine until failure occured.
Results: The mean of failure loads of MFP, CFP, and FFP were 315.8 N, 218.7 N and 146 N, respectively (P<0.05). 40% root fracture was observed in MFP group. Decementation was found in 90% of samples in FFP, and 40% in MFP and CFP.
Conclusion: This in vitro study showed that fiber post designs have an influence on fracture resistance and failure mode.

Open Access Original Research Article

Ascitic Fluid Fibronectin: A Marker to Differentiate Between Malignant and Non-malignant Ascites

E. E. L. Ekpe, E. C. Azinge, D. M. Bolarin

Journal of Advances in Medicine and Medical Research, Page 30-40
DOI: 10.9734/BJMMR/2015/12615

Background and Aims: So far, the differentiation between malignant and non-malignant ascites by laboratory parameters has not been fully achieved yet. Fibronectin is a glycoprotein which plays an important role in cell adhesion, growth, migration, and differentiation. The aim of the study was to assess the accuracy of fibronectin for the diagnosis of malignant ascites and to compare it with conventional use of cytology.
Study Design: A cross sectional study to determine the correlation between ascitic fluid fibronectin and malignant and non-malignant ascites.
Place and Duration of Study: This study was carried out at the clinics of gastroenterology, surgery, and obstetrics/gynecology at the Lagos University Teaching Hospital (LUTH), between August 2011 and July 2013.
Methods: Ascitic fluid and serum samples from 75 patients were taken. 37 of them (7 males and 30 females) had malignancy-related ascites (Group 1), while the other 38 (18 males and 20 females) had non-malignant ascites (Group 2) respectively. These were analysed for fibronectin, lactate dehydrogenase (LDH), total protein, and albumin. Cytology was also done for all ascitic fluid samples.
Results: Mean values of ascitic fluid fibronectin and LDH were higher in malignancy-related ascites (97.5 µg/ml, and 900.60 IU/L) respectively than in non-malignant ascites (47.7 µg/ml, and 199.31 IU/L) respectively (P less than 0.001). Ascitic fluid fibronectin with a cut-off value of 73 µg/ml gave the best diagnostic accuracy with a sensitivity and specificity of 94.7% and 94.6% respectively, while ascitic fluid LDH with a cut-off value of 310 IU/L gave diagnostic accuracy with a sensitivity and specificity of 97.3% and 84.2% respectively. The mean total protein level in the malignant group was 38.72±18.00 g/L and 30.21±15.00 g/L for the non-malignant group. The mean albumin levels were 28.08±10.32 g/L and 31.23±10.01 g/L for the malignant and non-malignant groups respectively. For both total protein and albumin, the P value was statistically insignificant. In this study, cytology yielded a sensitivity of 56.8% and a specificity of 100%.
Conclusion: The results of this study suggest that fibronectin concentration in ascitic fluid may be useful in differentiating malignant from non-malignant ascites and could supplement cytology in the differential diagnosis of ascites. Further studies are needed to confirm these results.

Open Access Original Research Article

Neurological Disorders Associated with Pregnancy: A Hospital Based Imaging Study of 57 Cases in North-East India

Dipu Bhuyan, Priyanka Baishya, Pradipta Ray Choudhury

Journal of Advances in Medicine and Medical Research, Page 41-51
DOI: 10.9734/BJMMR/2015/16221

Aims: To evaluate and characterize the Computed Tomography and Magnetic Resonance Imaging findings of the various neurological conditions of the central nervous system and pituitary gland that can occur during pregnancy and post partum period.
Place and Duration of Study: The study was carried out in the Department of Radiology, Gauhati Medical College and Hospital, Guwahati, from August 2012 to July 2013.
Methodology: A total of 57 patients of neurological disorders of the central nervous system and pituitary gland associated with pregnancy, who were referred to the Department for radiological evaluation and who had positive imaging findings were taken up for the study. CT scan was performed in those cases referred for imaging. For further evaluation, cases were referred to MRI or wherever possible, cases were directly referred for MRI. Contrast CT was avoided in most of the cases.
Results: Out of 57 patients, 54.39% patients were in age between 20 to 30 years. Headache was the most common presenting complaint (71.93%) in all the neurological disorders. Hypertensive encephalopathy (40.35%) was the most common neurological disorder followed by Cerebral Venous Thrombosis (17.54%). Infarct was the commoner complication of hypertensive encephalopathy accounting for 21.74% of cases. Magnetic resonance was able to detect infarct in 21.74% of cases compared to CT which could detect infarct in 13.04% of cases. P value 0.3534 and sensitivity 72%, 95% Confidence Interval 0.46 to 0.90 with negative predictive value 50% with 95% Confidence Interval 0.18 to 0.81.
Conclusion: Both CT and MRI can depict the characteristic imaging features of these neurological disorders in pregnancy as well as development of complications, hence leading to early and prompt diagnosis of these disorders and better management of these patients.

Open Access Original Research Article

Blood Cholinesterase Level and Learning Ability of Primary School Children in an Agricultural Village, Tanjung Karang, Malaysia

Nurul Husna Miswon, Zailina Hashim, Vivien How, Raihanah Chokeli

Journal of Advances in Medicine and Medical Research, Page 52-60
DOI: 10.9734/BJMMR/2015/16804

Objective: The widespread use of organophosphate (OP) insecticides in paddy fields has led to human exposure. The aim of this study was to determine the relationship between blood cholinesterase concentrations with the children’s learning ability in the agricultural village of Tanjung Karang, Selangor.
Methods: Seventy-seven primary school children who live less than approximately 1km from paddy fields were selected as the exposed group, while another 62 primary schoolchildren who live more than 1 km away from the agriculture site served as the unexposed group. The questionnaires were completed by the parents. The children’s capillary blood was collected using the finger prick technique to determine the blood cholinesterase concentrations using a cholinesterase test kit (Lovibond, AF267, Tintometer Ltd., UK). The McCarthy Scales of Children’s Abilities (MSCA) were used to determine the learning ability of these children.
Results: There were significant differences (p<0.05) in blood cholinesterase and all scales in the MSCA between the exposed and the unexposed group. There were significant associations between the blood cholinesterase concentrations and learning ability by all scales in the MSCA (p<0.05). The variable that significantly influenced the blood cholinesterase was gender (p=0.008). Blood cholinesterase was the most significant influencing factor on the learning ability, especially on the motor scale (p=0.002).
Conclusion: Blood cholinesterase concentrations were significantly higher and had a significant relationship with the learning ability of the exposed group, especially the motor performance.

Open Access Original Research Article

Infant Feeding Practices among HIV-Positive Women in Enugu, Nigeria

L. C. Ikeako, H. U. Ezegwui, M. I. Nwafor, E. Nwogu-Ikojo, T. C. Okeke

Journal of Advances in Medicine and Medical Research, Page 61-68
DOI: 10.9734/BJMMR/2015/16980

Background: Preventing transmission of HIV from mother to child after birth is one of the greatest challenges in HIV prevention.
Aim: To evaluate the infant feeding practices among HIV-positive mothers and the factors that influenced their decisions at the University of Nigeria Teaching Hospital, Enugu, Nigeria.
Methods: This was a questionnaire based cross-sectional study carried out at the paediatric HIV follow-up clinic between 1st January and 31st March 2014. Analysis was carried out using SSPS version 10.0 (Chicago IL, USA). P values less than 0.05 were considered significant.
Results: Fifty four HIV-Positive mothers were evaluated. The mean (standard deviation) for age of the respondents was 29.7 (4.2) years. Thirty two respondents (59.3%) practiced replacement feeding, 14(29.9%) practiced mixed feeding while 8(14.8%) practiced exclusive breast feeding. Of the mothers that practiced mixed feeding, 10(71.4%) did not receive counseling on infant feeding practices. Replacement feeding was adopted by 27 (84.4%) of respondents for fear of transmission of HIV to their children. Disclosure of status and counseling were independently significantly associated with the adoption of recommended infant feeding methods (EBF and RF) P<0.05.
Conclusion: Exposure to counseling on infant feeding methods was low. Current guidelines on infant feeding methods should be disseminated through structured counseling sessions at Maternity care centres for HIV-positive mothers.

Open Access Original Research Article

Prevalence of Depression, Anxiety and Stress (by DASS Scoring System) among Medical Students in Islamabad, Pakistan

Farwa Rizvi, Ayisha Qureshi, Abdul Majid Rajput, M. Afzal

Journal of Advances in Medicine and Medical Research, Page 69-75
DOI: 10.9734/BJMMR/2015/17193

Objective: To determine the prevalence of depression, anxiety and stress (by DASS scoring system) among purposive sample of medical students in Islamabad, Pakistan.
Study Design: Cross-sectional survey (June, 2014 to November, 2014)
Sampling Technique: Purposive sampling (non-probability)
Methods: The questionnaire used in this study consisted of three components: A socio-demographic questionnaire that required each student to provide their age, gender and year of study, as well as marks obtained as mean % scoring in the professional examinations and DASS scale (the Depression, Anxiety, and Stress Scale).
Procedure: Sixty-six medical students were the participants who were attending private and public medical universities in Pakistan. Following the granting of ethical approval from the university and medical college to conduct the study, medical students from first year to fifth year were contacted after purposive sampling and after the conclusion of one of their lectures. They were each given a questionnaire package to complete and return to the researcher before leaving the lecture room.
Results: The prevalence of depression was 40.9%, where 9.09% were mildly depressed, 16.67% moderately depressed, 13.64% severely depressed and 1.52% were extremely severely depressed. The prevalence of anxiety was 74.2%, where 13.64% were mildly anxious, 27.27% were moderately anxious, 19.70% were having severe anxiety and 13.64% were suffering from extremely severe anxiety. The prevalence of stress was 50%, out of which 18.18% were mildly stressed, 24.24% were moderately stressed and 7.58% were severely stressed.
Conclusion: There is a high prevalence of anxiety followed by stress and depression among the purposive sample of medical students during their academic training. Instructors, examiners, and universities should consider the stressors while assessing students on their academic basis.

Open Access Original Research Article

Utility of Chromogenic Disc Using Replication System versus Conventional Method for Detection of Uropathogens

Seema Bose, Atindra Krishna Ghosh

Journal of Advances in Medicine and Medical Research, Page 76-81
DOI: 10.9734/BJMMR/2015/17381

Aims: To evaluate utility of replication system using chromogenic disc for detection of uropathogens and to compare the result with conventional method for the same.
Design: A total of 625 urine samples were processed from suspected cases of urinary tract infection, admitted in a rural medical college of Maharashtra.
Methodology: The culture isolates of uropathogens were identified by both conventional method and by chromogenic disc using replica system.
Results: Out of 625 urine specimens, 419 (67.04%) were Culture positive. There was growth of Escherichia coli 197(99.49%), Enterococcus faecalis 88 (21%), Klebsiella pneumoniae 63 (15.03%) and Pseudomonas aeruginosa 10.73%. There was mixed growth of organisms 15(3.57%) in urine specimens. All uropathogens isolates were identified correctly by conventional as well as chromogenic disc using replica system, except one. One of the Escherichia coli isolate was identified by conventional methods but with replica system it showed colourless colonies instead of purple colonies.
Conclusion: Replica system is a rapid, cost effective and easy method for detection of uropathogens with satisfactory result. It can be adopted in clinical microbiology laboratory for presumptive diagnosis of uropathogens.